This invention relates to a pharmaceutical composition for and a method of treating leukemia in mammals, wherein the composition comprises a benzimidazole derivative.
Cancers, including leukemia, are the leading cause of death in animals and humans. The exact cause of many cancers is not known, but links between certain activities such as smoking or exposure to carcinogens and the incidence of certain types of carcinomas, lymphomas, e.g., leukemia and tumors, has been shown by a number of researchers.
Many types of chemotherapeutic agents have been shown to be effective against leukemia, but not all types of leukemia cells respond to these agents, and, unfortunately, many of these agents also destroy normal cells.
Despite advances in the field of leukemia treatments, the leading therapies to date are radiation, chemotherapy and bone marrow transplants. However, these therapies generally harm normal cells as well as leukemic cells. Ideally cytotoxic agents that have specificity for leukemia cells while only minimally affecting normal healthy cells would be extremely desirable. Unfortunately, none have been found and instead agents which target especially rapidly dividing cells (both diseased and normal) have been used.
The invention provides a method, and pharmaceutical composition therefor, of treating leukemia, inhibiting the growth or inhibiting the proliferation of leukemic cells while affecting little or no undesired side effects on normal cells, and extending the life span of a animal having leukemia. Accordingly, one aspect of the invention provides a method of treating leukemia in a animal comprising the step of administering to the animal a safe and effective amount of a compound of the Formula: 
or a pharmaceutically acceptable salt or prodrug form thereof, wherein:
X is hydrogen, halogen, alkyl of less than 7 carbon atoms or alkoxy of less than 7 carbon atoms;
n is a positive integer of less than 4;
Y is hydrogen, chlorine, nitro, methyl or ethyl;
R is hydrogen or an alkyl group of from 1 to 8 carbon atoms; or alkylcarbamoyl wherein the alkyl group has from 3 to 6 carbon atoms;
R2 is 4-thiazolyl or NHCOOR1; and
R1 is an aliphatic hydrocarbon of less than 7 carbon atoms; and
a pharmaceutically acceptable carrier.
Preferably the compositions are: 
wherein R is an alkyl of 1 through 8 carbon atoms and R2 is selected from the group consisting of 4-thiazolyl, NHCOOR1, wherein R1 is methyl, ethyl or isopropyl and the non-toxic, pharmaceutically acceptable acid addition salts with both organic and inorganic acids or prodrugs thereof.
R1 is preferably an alkyl group of less than 7 carbon atoms. In other preferred embodiments, R is an alkyl of from 1 to 8 carbon atoms and R1 is methyl, ethyl or isopropyl. The most preferred compounds include those wherein Y is chloro and X is hydrogen and also 2-(4-thiazolyl)benzimidazole (thiabendazole), methyl(butylcarbamoyl)-2-benzimidazolecarbamate (benomyl) and 2-(methoxycarbonylamino)benzimidzole(carbendazim).
The compound of the Formula I is used alone or in combination with a potentiator or other chemotherapeutic agent to treat leukemia.
Another aspect of the invention provides a method of inhibiting the proliferation of leukemic cells in vitro, in vivo or ex vivo comprising the step of treating said cells with an effective amount of the compound of the Formula I, as defined above. Optionally, one or more potentiators and chemotherapeutic agents are used in combination with the compound of the Formula I to inhibit the proliferation of leukemic cells.
Yet another aspect of the invention provides a method of inhibiting the growth of leukemic cells in vitro, in vivo or ex vivo comprising the step of treating said cells with an effective amount of the compound of the Formula I, as defined above. Optionally, one or more potentiators and chemotherapeutic agents are used in combination with the compound of the Formula I to inhibit the growth of leukemic cells.
Still another aspect of the invention provides a method of extending the life span of a animal having leukemia comprising the step of administering to the animal an effective amount of the compound of the Formula I, as defined above, whereby the life span of the animal is extended beyond the expected life span of a comparable animal having a comparable degree of leukemia development not being treated with a compound of the Formula I. Optionally, one or more potentiators and chemotherapeutic agents are used in combination with the compound of the Formula I to extend the life span of the animal.
A further aspect of the invention provides a pharmaceutical composition for the treatment of leukemia in a animal comprising a pharmaceutically acceptable carrier, an effective amount of a compound of the Formula I, as defined above, and a safe and effective amount of one or more potentiators and other chemotherapeutic agents.
The pharmaceutical composition of the invention includes all known stereoisomers, enantiomers, regioisomers, stereoisomers, and diastereomers of the compound of the Formula I as well as pharmaceutically acceptable salts and prodrugs thereof.
The compounds of the invention are administered orally, rectally, topically, intravenously, or parenterally.
A. Definitions
As used herein, xe2x80x9cFormula Ixe2x80x9d refers to a benzimidazole having the general formula: 
or a pharmaceutically acceptable salt or prodrug form thereof, wherein:
X is hydrogen, halogen, alkyl of less than 7 carbon atoms or alkoxy of less than 7 carbon atoms;
n is a positive integer of less than 4;
Y is hydrogen, chlorine, nitro, methyl or ethyl;
R is hydrogen or an alkyl group of from 1 to 8 carbon atoms; or alkylcarbamoyl wherein the alkyl group has from 3 to 6 carbon atoms;
R2 is 4-thiazolyl or NHCOOR1; and
R1 is an aliphatic hydrocarbon of less than 7 carbon atoms
As used herein, a xe2x80x9cpharmaceutically acceptablexe2x80x9d component is one that is suitable for use with humans and/or animals without undue adverse side effects (such as toxicity, irritation, and allergic response) commensurate with a reasonable benefit/risk ratio. It is expected, however, that some side effects may be observed during treatment with a compound of the Formula I.
As used herein, the term xe2x80x9canimalxe2x80x9d includes any warm blooded animal and the preferred animals are mammals.
As used herein, the term xe2x80x9csafe and effective amountxe2x80x9d or xe2x80x9ctherapeutically effective amountsxe2x80x9d refers to the quantity of a component which is sufficient to yield a desired therapeutic response without undue adverse side effects (such as toxicity, irritation, or allergic response) commensurate with a reasonable benefit/risk ratio when used in the manner of this invention. The specific xe2x80x9csafe and effective amountxe2x80x9d will vary with such factors as the particular condition being treated, the physical condition of the patient, the type of animal being treated, the duration of the treatment, the nature of concurrent therapy (if any), and the specific formulations employed and the structure of the compounds or its derivatives.
As used herein, the terms xe2x80x9cpharmaceutical addition saltxe2x80x9d and xe2x80x9cpharmaceutically acceptable saltxe2x80x9d refer to a salt of the anti-leukemia compound of the Formula I with an organic or inorganic acid. The preferred acid addition salts are chlorides, bromides, sulfates, nitrates, phosphates, sulfonates, formates, tartrates, maleates, malates, citrates, benzoates, salicylates, ascorbates, and the like.
xe2x80x9cProdrugsxe2x80x9d are considered to be any covalently bonded carriers which release the active parent drug according to the formula of the benzimidazole derivatives described above in vivo when such prodrug is administered to an animal subject. Prodrugs of the benzimidazole compounds are prepared by modifying functional groups present in the Examples of prodrugs include, but are not limited to, acetate, formate, or benzoate derivatives of alcohol and amine functional groups in the benzimidazole derivatives; phosphate esters, dimethylglycine esters, aminoalkylbenzyl esters, aminoalkyl esters and carboxyalkyl esters of alcohol and phenol functional groups in the benzimidazole derivatives; and the like.
As used herein, a xe2x80x9cpharmaceutical carrierxe2x80x9d is a pharmaceutically acceptable solvent, suspending agent or vehicle for delivering the compound of the Formula I to an animal or human. The carrier may be liquid or solid and is selected with the planned manner of administration in mind.
As used herein, xe2x80x9ccancerxe2x80x9d or xe2x80x9cleukemiaxe2x80x9d refers to neoplastic diseases which attack normal healthy blood cells, or bone marrow which produces blood cells, which are found in animals. The term xe2x80x9cleukemiaxe2x80x9d refers broadly to progressive, malignant diseases of the blood-forming organs and is generally characterized by a distorted proliferation and development of leukocytes and their precursors in the blood and bone marrow. Leukemia is generally clinically classified on the basis of (1) the duration and character of the disease, i.e., acute or chronic; (2) the type of cell involved; myeloid (myelogenous), lymphoid (lymphogenous), or monocytic; and (3) the increase or non-increase in the number abnormal cells in the blood-leukemic or aleukemic (subleukemic).
The P388 leukemia model described herein is widely accepted as being predictive of in vivo anti-leukemia activity. It is believed that compound that tests positive in the P388 assay will generally exhibit some level of anti-leukemia activity in vitro, ex vivo or in vivo. The level of anti-leukemia activity will depend upon the type of leukemia being treated. Accordingly, the present invention includes methods of treating leukemia, inhibiting the proliferation of leukemic cells, inhibiting the growth of leukemic cells or extending the life span of a animal having leukemia where the leukemia is selected from the group including acute nonlymphocytic leukemia, chronic lymphocytic leukemia, acute granulocytic leukemia, chronic granulocytic leukemia, acute promyelocytic leukemia, adult T-cell leukemia, aleukemic leukemia, a leukocythemic leukemia, basophylic leukemia, blast cell leukemia, bovine leukemia, chronic myelocytic leukemia, leukemia cutis, embryonal leukemia, eosinophilic leukemia. Gross leukemia, hairy-cell leukemia, hemoblastic leukemia, hemocytoblastic leukemia, histiocytic leukemia, stem cell leukemia, acute monocytic leukemia, leukopenic leukemia, lymphatic leukemia. lymphoblastic leukemia, lymphocytic leukemia, lymphogenous leukemia, lymphoid leukemia, lymphosarcoma cell leukemia, mast cell leukemia, megakaryocrytic leukemia, micromyeloblastic leukemia, monocytic leukemia, myeloblastic leukemia, myelocytic leukemia, myeloid granulocytic leukemia, myelomonocytic leukemia, Naegeli leukemia, plasma cell leukemia, plasmacytic leukemia, promyelocytic leukemia, Rieder cell leukemia, Schilling""s leukemia, stem cell leukemia, subleukemic leukemia, and undifferentiated cell leukemia.
As used herein, the term xe2x80x9csusceptible to treatmentxe2x80x9d refers to a leukemia which can be treated with a compound of the Formula I according to the methods of the invention. For example, leukemia which is susceptible to treatment will respond favorably to chemotherapy with a compound of the Formula I. A favorable response would include prolongation of the life span of a animal having the leukemia, inhibition of the proliferation of leukemic cells, inhibition of a growth of leukemic cells, reduction in the rate of disease progression in the animal, remission or regression of the disease in the animal, and/or improvement in the quality of life of a animal having leukemia. A leukemia can be identified as being susceptible to treatment by following the method of example 3 described below.
The compounds of the Formula I are prepared according to the method described in U.S. Pat. No. 3,738,995 issued to Adams et al., Jun. 12, 1973. The thiazolyl derivatives are prepared according to the method described in Brown et al. (J. Am. Chem. Soc. (1961), 83, 1764), and Grenda et al. (J. Org. Chem. (1965), 30, 259). Some of these compounds are also commercially available from BASF, Hoechst, E. I. Du Pont de Nemours, and MSD-AgVet. One skilled in the art of organic synthesis can easily determine methods to make the compounds of Formula I.
B. Adjunct Therapy
As used herein, xe2x80x9cadjunct therapyxe2x80x9d means that the patient in need of the drug is treated or given another drug for the disease and/or a potentiator in conjunction with the compound of the Formula I. This adjunct therapy can be sequential therapy where the patient is treated first with one compound and then the other within a given time period or concommitant therapy where the two compounds are administered substantially simultaneously or in overlapping dosing regimens.
The compound of the Formula I generally is used in single or multiple treatments. Alternatively, the compound of the Formula I is combined with other therapeutic agents, chemotherapeutic agents or potentiators to treat disorders. xe2x80x9cPotentiatorsxe2x80x9d are materials which affect the body""s response or diseased cell""s response to the compound of the Formula I. A xe2x80x9cpotentiatorxe2x80x9d can be any material which improves or increases the efficacy of a pharmaceutical composition containing the compound of the Formula I or acts as an immunomodulator to increase the efficacy of the compound of the Formula I.
In some embodiments of the invention, the compound of the Formula I is used in combination with one or more other anti-inflammatory, anti-viral, anti-fungal, amoebicidal, trichomonocidal, analgesic, anti-neoplastic, anti-hypertensives, anti-microbial and/or steroid drugs to treat leukemia and optionally another ongoing disease or disorder. An exemplary potentiator is triprolidine or its cis-isomer which are used in combination with chemotherapeutic agents and a compound of the Formula I. Triprolidine is described in U.S. Pat. No. 5,114,951 (1992). Another potentiator is procodazole, 1H-Benzimidazole-2-propanoic acid; [xcex2-(2-benzimidazole) propionic acid; 2-(2-carboxyethyl)benzimidazole; propazol]. Procodazole is a non-specific immunoprotective agent active against viral and bacterial infections that is used with the compositions claimed herein. It is effective with a compound of the Formula I in the methods of the invention. Procodazole can also be combined with a compound of the Formula I and other chemotherapeutic agents and used in the method of the invention.
Other potentiators which can be used with a compound of the Formula I, and optionally another chemotherapeutic agent, in the methods of the invention include macrophage colony-stimulating factor (M-CSF), 7-thia-8-oxoguanosine, 6-mercaptopurine, vitamin A (retinol), and other known anti-tumor potentiators which can be used in conjunction with the compounds of Formula I include, monensin, an anti-sense inhibitor of the RAD51 gene, bromodeoxyuridine, dipyridamole, indomethacin, a monoclonal antibody, an anti-transferrin receptor immunotoxin, metoclopramide, N-solanesyl-N,Nxe2x80x2-bis(3,4-dimethoxybenzyl)ethylenediamine, leucovorin, heparin, N-[4-[(4-fluorphenyl)sulfonly]phenyl]acetamide, heparin sulfate, cimetidine, a radiosensitizer, a chemosensitizer, a hypoxic cell cytotoxic agent, muramyl dipeptide, vitamin A, 2xe2x80x2-deoxycoformycin, a bis-diketopiperazine derivative, and dimethyl sulfoxide other anti-tumor potentiators.
The chemotherapeutic agents which can be used with a compound of the Formula I and an optional potentiator are generally grouped as DNA-interactive Agents, Antimetabolites, Tubulin-Interactive Agents, Hormonal agents and others such as Asparaginase or hydroxyarea. Each of the groups of chemotherapeutic agents can be further divided by type of activity or compound. For a detailed discussion of chemotherapeutic agents and their method of administration, see Dorr, et al, Cancer Chemotherapy Handbook, 2d edition, pages 15-34, Appleton and Lange (Connecticut, 1994) the disclosure of which is hereby incorporated by reference.
DNA-Interactive Agents include the alkylating agents, e.g. Cisplatin, Cyclophosphamide, Altretamine; the DNA strand-breaking agents, such as Bleomycin; the intercalating topoisomerase II inhibitors, e.g., Dactinomycin and Doxorubicin; the nonintercalating topoisomerase II inhibitors, such as Etoposide and Teniposide; and the DNA minor groove binder Plicamycin.
The alkylating agents form covalent chemical adducts with cellular DNA, RNA, and protein molecules and with smaller amino acids, glutathione and similar chemicals. Generally, these alkylating agents react with a nucleophilic atom in a cellular constituent, such as an amino, carboxyl, phosphate, sulfhydryl group in nucleic acids, proteins, amino acids, or glutathione. The mechanism and the role of these alkylating agents in cancer therapy is not well understood. Typical alkylating agents include:
Nitrogen mustards, such as Chlorambucil, Cyclophosphamide, Isofamide, Mechlorethamine, Melphalan, Uracil mustard;
Aziridine such as Thiotepa;
methanesulphonate esters such as Busulfan;
nitroso ureas, such as Carmustine, Lomustine, Streptozocin;
platinum complexes, such as Cisplatin, Carboplatin;
bioreductive alkylator, such as Mitomycin, and Procarbazine. Dacarbazine and Altretamine.
DNA strand breaking agents include Bleomycin.
DNA topoisomerase II inhibitors include the following:
Intercalators, such as Amsacrine, Dactinomycin, Daunorubicin, Doxorubicin, Idarubicin, and Mitoxantrone; and
nonintercalators, such as Etoposide and Teniposide.
The DNA minor groove binder is Plicamycin.
The antimetabolites interfere with the production of nucleic acids by one or the other of two major mechanisms. Some of the drugs inhibit production of the deoxyribonucleoside triphosphates that are the immediate precursors for DNA synthesis, thus inhibiting DNA replication. Some of the compounds are sufficiently like purines or pyrimidines to be able to substitute for them in the anabolic nucleotide pathways. These analogs can then be substituted into the DNA and RNA instead of their normal counterparts. The antimetabolites useful herein include:
folate antagonists such as Methotrexate and trimetrexate
pyrimidine antagonists, such as Fluorouracil, Fluorodeoxyunridine, CB3717, Azacitidine and Floxuridine
purine antagonists such as Mercaptopurine, 6-Thioguanine, Pentostatin;
sugar modified analogs such as Cytarabine and Fludarabine; and
ribonucleotide reductase inhibitors such as hydroxyurea.
Tubulin Interactive agents act by binding to specific sites on tubulin, a protein that polymerizes to form cellular microtubules. Microtubules are critical cell structure units. When the interactive agents bind on the protein, the cell can not form microtubules Tubulin Interactive agents include colchicine, Vincristine and Vinblastine, both alkaloids and Paclitaxel and cytoxan.
Hormonal agents are also useful in the treatment of cancers and tumors. They are used in hormonally susceptible tumors and are usually derived from natural sources These include:
estrogens, conjugated estrogens and Ethinyl Estradiol and Diethylstilbesterol. Chlortrianisen and Idenestrol;
progestins such as Hydroxyprogesterone caproate. Medroxyprogesterone, and Megestrol; and
androgens such as testosterone, testosterone propionate; fluoxymesterone. methyltestosterone.
Adrenal corticosteroids are derived from natural adrenal cortisol or hydrocortisone. They are used because of their anti inflammatory benefits as well as the ability of some to inhibit mitotic divisions and to halt DNA synthesis. These compounds include, Prednisone, Dexamethasone, Methylprednisolone, and Prednisolone.
Leutinizing hormone releasing hormone agents or gonadotropin-releasing hormone antagonists are used primarily the treatment of prostate cancer. These include leuprolide acetate and goserelin acetate. They prevent the biosynthesis of steroids in the testes.
Antihormonal antigens include:
antiestrogenic agents such as Tamoxifen,
antiandrogen agents such as Flutamide; and
antiadrenal agents such as Mitotane and Aminoglutethimide.
Hydroxyurea, which appears to act primarily through inhibition of the enzyme ribonucleotide reductase, can also be used in combination with the compound of the Formula I.
Asparaginase is an enzyme which converts asparagine to nonfunctional aspartic acid and thus blocks protein synthesis in the tumor. Asparaginase can also be used in combination with the compound of the Formula I to treat cancer.
Other chemotherapeutic benzimidazoles and griseofulvin can also be used in combination with the compound of the Formula I and optionally a potentiator to treat or inhibit the growth of cancer or extend the life span of a animal having cancer.
The amount and identity of a chemotherapeutic agent that is used with a compound of the Formula I in the methods of the invention will vary according to cellular response, patient response and physiology, type and severity of side effects, the disease being treated, the preferred dosing regimen, patient prognosis or other such factors.
The compound of the Formula I can be used in combination with one or more other agents or combination of agents known to possess anti-leukemia activity including, by way of example, xcex1-interferon; interleukin-2; cytarabine and mitoxantrone; cytarabine and daunorubicin and 6-thioguanine; cyclophosphamide and 2-chloro-2xe2x80x2-deoxyadenosine; VP-16 and cytarabine and idorubicin or mitoxantrone; fludarabine and cytarabine and xcex3-CSF; chlorambucil; cyclophosphamide and vincristine and (prednisolone or prednisone) and optionally doxorubicin; tyrosine kinase inhibitor; an antibody; glutamine; clofibric acid; all-trans retinoic acid; ginseng diyne analog; KRN8602 (anthracycline drug); temozolomide and poly(ADP-ribose) polymerase inhibitors; lysofylline; cytosine arabinoside; chlythorax and elemental enteral diet enriched with medium-chain triglycerides; amifostine; gilvusmycin; or a hot water extract of the bark of Acer nikoense. 
The compound of the Formula I can also be used in combination with other non-chemotherapeutic treatments for leukemia including bone marrow transplant, therapeutic apheresis, and radiation.
When a compound of the Formula I is used in combination with other therapeutic agents, the ratio of the compound of the Formula I to the other therapeutic agent will be varied as needed according to the desired therapeutic effect, the observed side-effects of the combination, or other such considerations known to those of ordinary skill in the medical arts. Generally, the ratio of the compound of the Formula I to other therapeutic agent will range from about 0.5%:99.5% wt. to about 99.5%:0.5% wt. Preferably from 1%:99% wt. to about 50%:50% wt. When the compound of the Formula I is administered before or after other therapeutic agents to treat viral infections, cancer, tumors, or other diseases, the respective doses and the dosing regimen of the compound of the Formula I and the other therapeutic agent may vary. The adjunct therapy can be sequential, that is the treatment with one agent first and then the second agent, or it can be concomitant treatment wherein two or more agents are administered substantially at the same time. The sequential therapy can be within a reasonable time after the completion of the first therapy before beginning the second therapy. The treatment with both agents at the same time can be in the same daily dose or in separate doses. For example treatment with one agent on day 1 and the other on day 2. The exact regimen will depend on the disease being treated, the severity of the infection and the response to the treatment.
For example, a full dosing regimen of the compound of the Formula I can be administered either before or after a full dosing regimen of the other therapeutic agent, or alternating doses of the compound of the Formula I and the other therapeutic agent may be administered. As a further example, the compound of the Formula I can be administered concomitantly with the other therapeutic agent.
Propionic acid and its salts and esters can also be used in combination with the pharmaceutical compositions claimed herein. Antioxidant vitamins such as vitamins A, C and E and beta-carotene can be added to these compositions.
C. Dosage and Delivery Forms
Any suitable dosage may be given in the method of the invention. The type of compound and the carrier and the amount will vary widely depending on the species of the warm blooded mammal, body weight, or the type of leukemia being treated. Generally a dosage of between about 2 milligram (mg) per kilogram (kg) of body weight and about 10000 mg per kg of body weight is suitable for the compound of the Formula I. Preferably from 150 mg to about 8000 mg/kg of body weight is used.
A dosage unit may comprise a single compound or mixtures thereof with other compounds or other cancer inhibiting compounds. The dosage unit can also comprise diluents, extenders, carriers, liposomes and the like. The unit may be in solid or gel form such as pills, tablets, capsules and the like or in liquid form suitable for oral, rectal, topical, intravenous injection or parenteral administration or injection into or around the bone marrow.
The dosage for the chemotherapeutic agent can be from about 1 mg to about 1000 mg/kg and will be the same as or less than the dosage normally used for that agent.
The range and ratio of the compound of the Formula I to chemotherapeutic agent will depend on the type of cancer or tumor being treated and the particular chemotherapeutic agent. Generally the range of dosage for the chemotherapeutic agent will the same as or lower than that used when the chemotherapeutic agent is used alone. The ratio of the compound of the Formula I to the chemotherapeutic agent will generally be in the range of about 1000:1 to 10:1, and preferably in the range of about 800:1 to 100:1 on a weight basis. Generally, about 500 mg to 5000 mg of the compound of the Formula I/kg of body weight is administered when about 0.5 to about 40 mg of the chemotherapeutic/kg of body weight is administered.
Any range of doses can be used. Generally the compound of the Formula I can be administered on a daily basis one or more times a day, or the compound of the Formula I can be given once to four times a week either in a single dose or separate doses during the day. Twice weekly dosing over a period of several weeks is preferred. However, the dosage and the dosage regimen will vary depending on the ability of the patient to sustain the desired and effective plasma levels of the the compound of the Formula I in the blood.
The identity of the chemotherapeutic agent, the pharmaceutical carrier and the amount of compound administered will vary widely depending on the species and body weight of mammal and the type of leukemia being treated. The dosage administered will vary depending upon known factors, such as the pharmacodynamic characteristics of a specific chemotherapeutic agent and its mode and route of administration; the age, sex, metabolic rate, absorptive efficiency, health and weight of the recipient; the nature and extent of the symptoms; the kind of concurrent treatment being administered; the frequency of treatment with; and the desired therapeutic effect.
The compound of the Formula I, the potentiator and the chemotherapeutic agent are administered together in a single dosage form or separately in two or more different dosage forms. These can be administered independently by the same route or by two or more different routes of administration depending on the dosage forms employed.
The compound of the Formula I is preferably micronized or powdered so that it is more easily dispersed and solubilized by the body. Processes for grinding or pulverizing drugs are well known in the art. For example, a hammer mill or similar milling device are used.
Dosage forms (compositions) suitable for internal administration contain from about 1.0 milligram to about 5000 milligrams of active ingredient per unit. In these pharmaceutical compositions, the active ingredient will ordinarily be present in an amount of about 0.5 to about 95% by weight based on the total weight of the composition. Based on the body weight of the patient, the dosage may be administered in one or more doses several times per day or per week. Multiple dosage units may be required to achieve a therapeutically effective amount. For example, if the dosage form is 1000 mg, and the patient weighs 40 kg, one pill will provide a dose of 25 mg per kg for that patient. It will provide a dose of only 12.5 mg/kg for a 80 kg patient.
The compound of the Formula I has exhibited efficacy in vivo against leukemia in mice at doses of about 1000, 2000 and 4000 mg/kg. Generally, an effective dose in mice is about 12 times the expected effective dose in humans. By way of general guidance, for humans a dosage of as little as 20 milligrams (mg) per kilogram (kg) of body weight and up to about 10,000 mg per kg of body weight is suitable as a therapeutically effective dose. Preferably, from about 150 mg/kg to about 5,000 mg/kg of body weight is used. Other preferred doses range between 100 mg/kg to about 3000 mg/kg of body weight. However, a dosage of between about 2 milligrams (mg) per kilogram (kg) of body weight to about 400 mg per kg of body weight is also suitable for treating some forms of leukemia.
Suitable pharmaceutical compositions and dosage forms will preferably comprise the compound of the Formula I, a potentiator and optionally a chemotherapeutic agent. The ratio of the compound of the Formula I to potentiator is generally in the range of about 1000:1 to 1:1, and preferably 500:1 to 10:1 on a weight basis. When a chemotherapeutic agent is also present, the ratio of the compound of the Formula I to potentiator to chemotherapeutic agent is generally in the range of about 1000:1:1 to about 1:1:1, and preferably 500:1: to about 300:100.
Generally about 2 to 1000 mg of the compound of the Formula I per kg of body weight is administered when about 2 to 500 mg of potentiator/kg of body weight and about 0.5 to 100 mg of chemotherapeutic agent/kg of body weight are administered.
Intravenously, the most preferred rates of administration may range from about 1 to about 1000 mg/kg/minute during a constant rate infusion. The compound of the Formula I may be administered in a single daily dose, or the total daily dosage may be administered in divided doses of two, three, or four times daily. The compound of the Formula I is generally given in one or more doses on a daily basis or from one to three times a week.
The compound of the Formula I is administered by any conventional means available for use in conjunction with pharmaceuticals, either as individual therapeutic agents or in combination with other therapeutic agents.
A dosage unit may comprise a single compound or mixtures thereof with other anti-cancer compounds, other cancer or tumor growth inhibiting compounds. The compound of the Formula I can be administered in oral dosage forms as tablets, capsules, pills, powders, granules, elixirs, tinctures, suspensions, syrups, and emulsions. The compound of the Formula I may also be administered in intravenous (bolus or infusion), intraperitoneal, subcutaneous, or intramuscular form, all using dosage forms well known to those of ordinary skill in the pharmaceutical arts.
The compound of the Formula I is typically administered in admixture with suitable pharmaceutical diluents, extenders, excipients, or carriers (collectively referred to herein as a pharmaceutically acceptable carrier or carrier materials) suitably selected with respect to the intended form of administration and as consistent with conventional pharmaceutical practices. The unit will be in a form suitable for oral, rectal, topical, intravenous injection or parenteral administration.
The compound of the Formula I can be administered alone but is generally mixed with a pharmaceutically acceptable carrier. This carrier can be a solid or liquid, and the type of carrier is generally chosen based on the type of administration being used.
Specific examples of pharmaceutical acceptable carriers and excipients that may be used to formulate oral dosage forms of the present invention are described in U.S. Pat. No. 3,903,297 to Robert, issued Sep. 2, 1975. Techniques and compositions for making dosage forms useful in the present invention are described in the following references: 7 Modern Pharmaceutics, Chapters 9 and 10 (Banker and Rhodes, Editors, 1979); Pharmaceutical Dosage Forms: Tablets (Lieberman et al., 1981); Ansel, Introduction to Pharmaceutical Dosage Forms 2nd Edition (1976): Remington""s Pharmaceutical Sciences, 17th ed. (Mack Publishing Company. Easton, Pa., 1985); Advances in Pharmaceutical Sciences (David Ganderton, Trevor Jones. Eds., 1992); Advances in Pharmaceutical Sciences Vol 7. (David Ganderton. Trevor Jones. James McGinity, Eds., 1995); Aqueous Polymeric Coatings for Pharmaceutical Dosage Forms (Drugs and the Pharmaceutical Sciences, Series 36 (James McGinity,, Ed.. 1989); Pharmaceutical Particulate Carriers: Therapeutic Applications: Drugs and the Pharmaceutical Sciences, Vol 61 (Alain Rolland, Ed., 1993); Drug Deliver) to the Gastrointestinal Tract (Ellis Horwood Books in the Biological Sciences. Series in Pharmaceutical Technology; J. G. Hardy, S. S. Davis, Clive G. Wilson, Eds.); Modern Pharmaceutics Drugs and the Pharmaceutical Sciences, Vol 40 (Gilbert S. Banker, Christopher T. Rhodes, Eds.), the disclosures of which are hereby incorporated by reference.
Tablets may contain suitable binders, lubricants, disintegrating agents, coloring agents, flavoring agents, flow-inducing agents, and melting agents. For instance, for oral administration in the dosage unit form of a tablet or capsule, the active drug component can be combined with an oral, non-toxic, pharmaceutically acceptable, inert carrier such as lactose, gelatin, agar, starch, sucrose, glucose, methyl cellulose, magnesium stearate, dicalcium phosphate, calcium sulfate, mannitol, sorbitol and the like.
Suitable binders include starch, gelatin, natural sugars such as glucose or beta-lactose, corn sweeteners, natural and synthetic gums such as acacia, tragacanth, or sodium alginate, carboxymethylcellulose, polyethylene glycol, waxes, and the like. Lubricants used in these dosage forms include sodium oleate, sodium stearate, magnesium stearate, sodium benzoate, sodium acetate, sodium chloride, and the like. Disintegrators include, without limitation, starch, methyl cellulose, agar, bentonite, xanthan gum, and the like.
The compound of the Formula I can also be administered in the form of liposome delivery systems, such as small unilamellar vesicles, large unilamallar vesicles, and multilamellar vesicles. Liposomes can be formed from a variety of phospholipids, such as cholesterol, stearylamine, or phosphatidylcholines.
The compound of the Formula I may also be coupled to soluble polymers as targetable drug carriers or as a prodrug. Such polymers include polyvinylpyrolidone. pyran copolymer, polyhydroxylpropylmethacrylamide-phenol, polyhydroxyethylaspartamidephenol, or polyethyleneoxide-polylysine substituted with palmitoyl residues. Furthermore, the compound of the Formula I may be coupled to a class of biodegradable polymers useful in achieving controlled release of a drug, for example, polylactic acid, polyglycolic acid, copolymers of polylactic and polyglycolic acid, polyepsilon caprolactone, polyhydroxy butyric acid, polyorthoesters, polyacetals, polydihydropyrans, polycyanoacylates, and crosslinked or amphipathic block copolymers of hydrogels.
The active ingredient can be administered orally in solid dosage forms, such as capsules, tablets, and powders, or in liquid dosage forms, such as elixirs, syrups, and suspensions. It can also be administered parentally, in sterile liquid dosage forms.
Gelatin capsules may contain the active ingredient and powdered carriers, such as lactose, starch, cellulose derivatives, magnesium stearate, stearic acid, and the like. Similar diluents can be used to make compressed tablets. Both tablets and capsules can be manufactured as immediate release products or as sustained release products to provide for continuous release of medication over a period of hours. Compressed tablets can be sugar coated or film coated to mask any unpleasant taste and protect the tablet from the atmosphere, or enteric coated for selective disintegration in the gastrointestinal tract.
For oral administration in liquid dosage form, the oral drug components are combined with any oral, non-toxic, pharmaceutically acceptable inert carrier such as ethanol, glycerol, water, and the like. Examples of suitable liquid dosage forms include solutions or suspensions in water, pharmaceutically acceptable fats and oils, alcohols or other organic solvents, including esters, emulsions, syrups or elixirs, suspensions, solutions and/or suspensions reconstituted from non-effervescent granules and effervescent preparations reconstituted from effervescent granules. Such liquid dosage forms may contain, for example, suitable solvents, preservatives, emulsifying agents, suspending agents, diluents, sweeteners, thickeners, and melting agents.
Liquid dosage forms for oral administration can contain coloring and flavoring to increase patient acceptance. In general, water, a suitable oil, saline, aqueous dextrose (glucose), and related sugar solutions and glycols such as propylene glycol or polyethylene glycols are suitable carriers for parenteral solutions. Solutions for parenteral administration preferably contain a water soluble salt of the active ingredient. suitable stabilizing agents, and if necessary, buffer substances. Antioxidizing agents such as sodium bisulfite, sodium sulfite, or ascorbic acid, either alone or combined, are suitable stabilizing agents. Also used are citric acid and its salts and sodium EDTA. In addition, parenteral solutions can contain preservatives, such as benzalkonium chloride, methyl- or propyl-paraben, and chlorobutanol. Suitable pharmaceutical carriers are described in Remington""s Pharmaceutical Sciences, Mack Publishing Company, a standard reference text in this field.
The compound of the Formula I may also be administered in intranasal form via use of suitable intranasal vehicles, or via transdermal routes, using those forms of transdermal skin patches well known to those of ordinary skill in that art. To be administered in the form of a transdermal delivery system, the dosage administration will generally be continuous rather than intermittant throughout the dosage regimen.
Parenteral and intravenous forms may also include minerals and other materials to make them compatible with the type of injection or delivery system chosen.
Useful pharmaceutical dosage forms for administration of the compound of the Formula I are illustrated as follows:
Capsules
A large number of unit capsules are prepared by filling standard two-piece hard gelatin capsules each with 100 to 500 milligrams of powdered active ingredient, 5-150 milligrams of lactose, 5-50 milligrams of cellulose, and 6 milligrams magnesium stearate.
Soft Gelatin Capsules
A mixture of active ingredient in a digestible oil such as soybean oil, cottonseed oil or olive oil is prepared and injected by means of a positive displacement pump into gelatin to form soft gelatin capsules containing 100-500 milligrams of the active ingredient. The capsules are washed and dried.
Tablets
A large number of tablets are prepared by conventional procedures so that the dosage unit was 100-500 milligrams of active ingredient. 0.2 milligrams of colloidal silicon dioxide, 5 milligrams of magnesium stearate, 50-275 milligrams of microcrystalline cellulose, 11 milligrams of starch and 98.8 milligrams of lactose Appropriate coatings may be applied to increase palatability or delay absorption.
Injectable solution
A parenteral composition suitable for administration by injection is prepared by stirring 1.5% by weight of active ingredient in 10% by volume propylene glycol and water. The solution is made isotonic with sodium chloride and sterilized.
Suspension
An aqueous suspension is prepared for oral administration so that each 5 ml contain 100 mg of finely divided active ingredient, 200 mg of sodium carboxymethyl cellulose, 5 mg of sodium benzoate, 1.0 g of sorbitol solution, U.S.P., and 0.025 ml of vanillin.
The present invention also includes pharmaceutical kits useful, for example, for the treatment of cancer, which comprise one or more containers containing a pharmaceutical composition comprising a therapeutically effective amount of the compound of the Formula I. Such kits may further include, if desired, one or more of various conventional pharmaceutical kit components, such as, for example, containers with one or more pharmaceutically acceptable carriers, additional containers, etc., as will be readily apparent to those skilled in the art. Printed instructions, either as inserts or as labels, indicating quantities of the components to be administered, guidelines for administration, and/or guidelines for mixing the components, may also be included in the kit. It should be understood that although the specified materials and conditions are important in practicing the invention, unspecified materials and conditions are not excluded so long as they do not prevent the benefits of the invention from being realized.
The chemotherapeutic agents, the compound of the Formula I and, optionally, the potentiators are typically mixed with a pharmaceutically acceptable carrier. This carrier can be a solid or liquid and the type is generally chosen based on the type of administration being used. The active agent can be coadministered in the form of a tablet or capsule, liposome, as an agglomerated powder or in a liquid form. Examples of suitable solid carriers include lactose, sucrose, gelatin and agar. Capsule or tablets can be easily formulated and can be made easy to swallow or chew; other solid forms include granules, and bulk powders. Tablets may contain suitable binders, lubricants, diluents, disintegrating agents, coloring agents, flavoring agents, flow-inducing agents, and melting agents. Examples of suitable liquid dosage forms include solutions or suspensions in water, pharmaceutically acceptable fats and oils, alcohols or other organic solvents, including esters, emulsions, syrups or elixirs, suspensions, solutions and/or suspensions reconstituted from non-effervescent granules and effervescent preparations reconstituted from effervescent granules. Such liquid dosage forms may contain, for example, suitable solvents, preservatives, emulsifying agents, suspending agents, diluents, sweeteners, thickeners, and melting agents. Oral dosage forms optionally contain flavorants and coloring agents. Parenteral and intravenous forms would also include minerals and other materials to make them compatible with the type of injection or delivery system chosen.
The compound of the Formula I is generally safe. The LD50 is 50,000 mg/kg when given orally in a mouse. There are generally no special handling requirements. The compound of the Formula I can be given orally, and as it is not very water soluble, it is preferably given in tablet form or as a suspension.
D. Method of Treatment
The method of treatment can be any suitable method which is effective in the treatment of the particular cancer or tumor type being treated. Treatment may be oral, rectal, topical, parenteral or intravenous administration or by injection into the tumor or cancer. The method of applying an effective amount also varies depending on the disorder being treated. It is believed that parenteral treatment by intravenous, subcutaneous, or intramuscular application of the the compound of the Formula I, formulated with an appropriate carrier, additional cancer inhibiting compound or compounds or diluent to facilitate application will be the preferred method of administering the compounds to warm blooded animals.
In addition to the use of chemotherapeutic agents and potentiators, the compound of the Formula I can be combined with other therapeutic agents. Preferred adjuvants include griseofulvin, fluoconazole, glyphosate and propicodazole. The dosage level of these compounds when used in conjunction with the compound of the Formula I will be from about 150 mg/kg to about 6000 mg/kg.
The following examples illustrate the utility of the compound of the Formula I as an anti-leukemia agent.